Corticosteroid Injections – Some facts behind the myths!

At some point many of us have had or heard of someone who has had a corticosteroid “cortisone” injection. In my talks with patients over the years cortisone can often get a ‘bad rap’ if they have had a negative experience (i.e. it was ineffective or painful!) The truth is, if used correctly and in the hands of an expert it is a powerful and effective way of managing some inflammatory conditions. So much so, that we can often see instant relief of a condition that has proven stubborn to many other types of more conservative treatment.

Corticosteroids are a type of medication that are related to cortisone, a steroid. Drugs of this class powerfully reduce inflammation; however, they are not painkillers. When corticosteroids reduce pain, it is as a result of reduced inflammation associated with that condition. While the inflammation for which corticosteroids are given can reoccur, corticosteroid injections can provide long lasting relief when used properly. Some examples of common conditions that a cortisone injection may be useful for include:

bursitis

osteoarthritis

frozen shoulder

shoulder impingement and rotator cuff pathologies

tennis elbow

painful foot conditions such as plantar fasciitis

Cortisone is a common treatment prescribed for a wide variety of issues and there is a lot of information and misinformation surrounding the use of these injections.

True OR False ?

‘Cortisone injections generally cause more harm than good.’

Patients are often concerned when they hear that a cortisone injection has been suggested. While it is true that these injections should not be done constantly, the majority of specialists agree that cortisone injections, when used appropriately, pose very little risk to your body.

‘Cortisone injections function as pain relievers.’

Cortisone is NOT a painkiller. Although an injection may relieve your pain, this is due to its anti-inflammatory properties.

‘A cortisone injection will affect other parts of my body.’

Because the injection contains only a small amount of cortisone, and it is injected into or around a specific structure, cortisone generally does not affect other parts of the body.

‘Cortisone injections work quickly.’

When you receive a cortisone injection a small amount of Lidocaine (anaesthetic) is injected simultaneously with the cortisone. Therefore you may feel better instantly because your pain receptors are numbed. However, after the Lidocaine wears off you may experience slight discomfort. The cortisone needs time to bring down the inflammation before the pain relief starts and this can take between 3-7 days.

‘Cortisone injections will be very painful.’

In an expert’s hands, the opposite is more often the case. Minimal pain from the procedure is noted while relief from the pain of the inflammation occurs rapidly. Also, pain after the injection is not common or anticipated.

‘Cortisone injections have a lot of side effects.’

Side effects of cortisone injections are very rare and uncommon. In a very small number of cases side effects can include depigmentation (lightening of the colour) around the injections site, soreness at the site and an aggravation of the inflamed area because of a short-term reaction to the medication (post injection flare).

When administered by an expert, cortisone injections offer significant pain relief from inflammation with only minimal discomfort.

No one can predict to what degree cortisone will help your symptoms and for how long. Cortisone’s ability to work is entirely based on the individual’s body.

As stated previously, Cortisone is purely an anti-inflammatory and will not change any of the underlying risk factors or causes of the condition. Therefore, in clinic we use it as a last resort if other conservative treatments have been ineffective or as an aid to enable rehabilitation which can in turn go on to enable a full recovery.

For this reason steroid injections can have several outcomes:

Full resolution of symptoms with no recurrence.

Full resolution of symptoms for minimum or moderate period followed by a recurrence.

Minimum / Moderate resolution of symptoms followed by 2-3 further injections at varying intervals.

Rarely, no change in symptoms

It is likely that people who experience 1 or 2 will highly recommend the injection to others. At the other end of the spectrum, these people will likely give the injection a “thumbs down” and usually go on to tell their friends the negative experience they have had. Reasons why an injection may not have been successful are as follows:

the condition did not warrant an injection

the injection was poorly executed and missed the inflamed structure

the structure did not have an inflammatory pathology within it

In my experience people who show either of numbers 2, 3 or 4 (above) need to explore further into the underlying cause of their condition. This is where physiotherapy can be of most assistance. Our background training is to understand and manage the underlying causes and associated risk factors for various conditions. Exercises, retraining, advice and hands on manual therapy are all techniques that will aid in correcting the “driver” of a condition and give you a far better outcome, even if an injection is then later required.

CASE STUDY

I had a patient who had a stubborn knee condition and was unable to perform some of their necessary rehabilitation exercises due to the pain. I subsequently referred them to our on-site Injection specialist, Patrick Bradley. He performed the steroid injection to the affected area resulting in the patient immediately reporting 80% pain relief. This was enough to enable the exercises to be performed with more comfort which successfully changed the underlying cause of the condition and in turn allowed a full recovery.

As with any invasive technique it is important to understand the associated risks and benefits with that procedure. For further information about injections or physiotherapy treatment please contact us on 01706 522 922 and we will be happy to help.

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Bradley Physio

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Established in 1997 Bradley Physio has a wealth of knowledge & experience in speedy diagnosis, effective treatment & rehabilitation following an injury. Regularly hosting a variety of courses throughout the year ensures the whole team have up to date knowledge of the latest advances in the management of musculoskeletal conditions so that Bradley Physio remains one of the leading physiotherapy clinics in the North West.